The Potential Use of Maternal Size in Priority Setting When Combating Childhood Malnutrition

Published paper

A perennial problem for those conducting nutritional surveys in emergency situations is the interpretation of high levels of malnutrition. Are high levels of wasting due to food insecurity, poor maternal care and/or inadequate public health measures? Without this knowledge it is difficult to know which interventions are most appropriate. A recent study on the potential use of maternal size in priority setting when combating childhood malnutrition may chart the way forward and out of this confusion.

The objective of the study was to devise a strategy for assessing the nutritional status of a household and specifying the major needs in combating childhood wasting, distinguishing between inadequate food availability, poor parental care and/or the need for improved public health measures.

The study was designed to evaluate the relationship between children's wasting, stunting or underweight and mothers or adult women's body mass index in the same household. Data sets from past surveys in Ethiopia, India and Zimbabwe were used. A household was designated as 'malnourished' on the basis of a single child's weight/height being < -2.0 S.D. or at risk of being malnourished if the Z score was below - 1.5. Adult women's BMIs were taken to signify adequacy of household food availability. There is an extensive literature showing the response in adult body weight to a reduction in food intake and the seasonal fluctuations in adult weights in developing countries when food availability is known to be limited. Possible alternative explanations, e.g. chronic intestinal disease, trace element deficiencies sufficient to induce anorexia or HIV would have to be very widespread to explain the patterns observed in these studies.

Results

There were wide variations in prevalences of severe, (BMI<16), moderate (BMI 16-16.9) and marginal malnutrition (BMI 17-18.4) amongst adult women in the various study areas. The worst condition was recorded in India while 18% of women in Zimbabwe were classified as obese. Similarly wide variation in the prevalence of child wasting and stunting was observed with the Indian children again faring worst and those in Zimbabwe the best. The BMI of mothers was highly correlated with the BMI of all other adult women in the same household.

In this study, households with mothers of normal body weight but wasted children were designated as in need of public health measures and improved parental care rather than enhanced food security. The distribution of households on this combined basis of maternal BMI and child nutritional status highlighted very diverse situations in the various study areas, with higher proportions of combined maternal and child malnutrition in India and in some areas of Ethiopia, while in Zimbabwe only 1-2% of households presented this condition.

On this basis the study concluded that the principal problem in India was food insecurity while in Zimbabwe household insecurity was rarely apparent, so public health measures and maternal care were designated as problems where child malnutrition existed. In three Ethiopian communities there was a mixture of needs.

The study authors assert that this approach not only considers households as the key for analysis but uses family data to guide policy. However, they also caution that whether this approach proves to be of value will depend on testing it under field conditions.